Provider Demographics
NPI:1467767012
Name:AHPC PHOENIX, LLC
Entity Type:Organization
Organization Name:AHPC PHOENIX, LLC
Other - Org Name:AT HOME PERSONAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTY
Authorized Official - Middle Name:
Authorized Official - Last Name:BUSKIRK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-746-5558
Mailing Address - Street 1:4500 N 32ND ST STE 107
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85018-3350
Mailing Address - Country:US
Mailing Address - Phone:480-497-4347
Mailing Address - Fax:480-926-0221
Practice Address - Street 1:2444 E SOUTHERN AVE STE 107
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85204-5418
Practice Address - Country:US
Practice Address - Phone:480-497-4347
Practice Address - Fax:480-926-0221
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-06
Last Update Date:2010-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZHHA4863253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care